Tegan Taylor: So, Norman, you were mentioning before some controversy around a mismatch between the World Health Organisation's guidelines and the Australian guidelines about what milks are appropriate to give to babies, especially babies as young as six months. And it kind of follows on from some of the reporting you've been doing in the last few weeks for us around toddler foods and toddler milks.
Norman Swan: Yeah, so the World Health Organisation puts out infant feeding and child feeding guidelines, and they change them every so often, and they've changed the infant feeding guidelines over the last few days to cover babies between six months and a year old or six and 11 months, who are not breastfed, and they've said for the first time that they can have cow's milk. And authorities and experts in Australia have been…I suppose they've been outraged by it because it doesn't comply with Australian infant feeding guidelines. And it highlights some of the disparities that can occur between the World Health Organisation that's trying to get a global view and global advice going, versus countries like Australia, which are very different from low-income countries.
And another reason, Tegan, I'm interested in this is that…and I cover this in the interview so I won't go into any great detail…is that paediatricians in Australia and allergists in Australia bend over backwards to comply with World Health Organisation feeding guidelines, sometimes to the detriment of kids who run the risk of developing food allergies. But have a listen to this interview that I did earlier with Rachel Laws, who's Associate Professor of Public Health Nutrition at Deakin University.
Rachel Laws: The latest WHO recommendations are that non-breastfed infants between six and 11 months can be fed either formula or animal milk, and that's different to what the Australian infant feeding guidelines recommend, that in infants less than 12 months that cow's milk isn't given as the main drink.
Norman Swan: Now, they weren't terribly confident about this. What's led to it?
Rachel Laws: WHO guidelines obviously cover a range of countries. And these guidelines are really in place for countries where there is limited access to animal foods, there may be unsafe water, unsafe sanitation or indeed access to infant formula, and in those countries, animal milks may indeed be a preferred option. But clearly this isn't the case in Australia.
Norman Swan: Rachel, what was the evidence that they based this decision on?
Rachel Laws: WHO undertook a systematic review, which is an evidence synthesis of trying to pull together results from a number of studies, and they included nine studies. A few of these studies were conducted more than 20 years ago and all were of low quality, which means that we can just be less confident in the results of those studies.
Norman Swan: So what's the problem with cow's milk from six months?
Rachel Laws: The main problem with cow's milk from six months of age is the evidence that cow's milk at between six and 11 months of age has been associated with an increased risk of iron deficiency anaemia. When infants are around six months of age, their needs for iron increase. And there's quite reasonable evidence that cow's milk can increase the risk of iron deficiency anaemia in children under 12 months of age. And there's also concerns about the protein level in cow's milk, which is double the protein content of both breast milk and formula. And we know that high intakes of protein in early infancy are associated with an increased risk of obesity.
Norman Swan: So at its core, this is all about a period of a child's life when they're dependent on milk.
Rachel Laws: Correct. And ideally breastfeeding is the preferred form of milk and fluids at that age. But in the case where parents aren't breastfeeding, then the Australian infant feeding guidelines do continue to recommend formula milk as the other alternative.
Norman Swan: There's something else I wanted to ask you about the WHO guidelines because when you look at the evidence, introducing solids early prevents food allergies, not 100% but reduces the risk of food allergy. And yet you've got paediatricians and paediatric allergists really being a bit nervous about saying that at four or five months you should introduce solids, they really go with six months. And when you ask them why (because that condemns some children to food allergies, waiting to six months), they say, well, we don't want to contradict the WHO guidelines because WHO guidelines say no solids until after six months. Are the WHO guidelines just becoming a bit irrelevant for countries like Australia?
Rachel Laws: Well, the Australian infant feeding guidelines also recommend introducing solids around six months.
Norman Swan: But what I understand is they're following WHO guidelines and WHO guidelines are no longer in tune with the evidence.
Rachel Laws: I think there's a range of evidence. The allergy field is one area, but the other area is child obesity. And we do know that there's some evidence that early introduction of solids before four months of age is associated with an increased risk of obesity. And I think the guidelines around allergies are introducing solids around six months of age, but not before four months of age. So I think that's the critical message here.
Norman Swan: But still questions whether WHO can ever fulfil the need to be global when they're dealing with so many different countries at different levels of nutritional availability.
Rachel Laws: I think that's a very fair point, Norman. And they do say in their guidelines that this is a conditional recommendation. And that means that the recommendations do vary by context, and that each country needs to consider the balance of the benefits versus the harms. And our National Health and Medical Research Council have actually just released a statement on their website in the last day or so that does reinforce sticking with the current infant feeding guidelines of not feeding cow's milk or animal milks to infants under 12 months of age as the main drinks.
Norman Swan: Rachel, thank you very much for joining us.
Rachel Laws: Thanks very much.
Norman Swan: So I think what that means is it's business as usual, Tegan, that the advice for Australian mothers and fathers of infants is, if they're being formula fed, keep them formula fed until they are 12 months old and then start introducing cow's milk, along with water, because they're getting most of their nutrition from solids.
Tegan Taylor: You're listening to the Health Report.
The World Health Organisation recently updated their infant feeding guidelines to say babies as young as six months can start drinking cow’s milk rather than infant formula.
That could be a good thing if you have challenges accessing safe drinking water, but in Australia it goes against the national guidelines.
Associate Professor Rachel Laws, from Deakin University’s Institute for Physical Activity and Nutrition, says it's confusing messaging for Australian parents.
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